Tag: Childhood

Borderline Personality Disorder: Partner of someone with BPD and other diagnoses.


Q. I do not have BPD; I am, however, a co-dependent personality (3 marriages – one a schizophrenic, one an alcoholic and the most recent BPD). Although my Vietnam vet husband has been diagnosed as suffering from PTSD, came from an unhappy childhood and has suffered through two major “breakdowns” in the past 10 years, he has never been definitely diagnosed as BPD to my knowledge. He is currently diagnosed as suffering from manic depressive disorder, adjustment disorder, obsessive compulsive personality disorder, and passive aggressive personality disorder.

We have been together for 12 years; I have read the “DSM definition of BPD” and can state that every indicator with the exception of suicide and/or self-mutilation is STRONGLY AND OBVIOUSLY present in my husband.

He is currently taking Depakote, Wellbutrin, Xanax and Zoloft. I don’t understand how his doctors could have missed the diagnosis; he has been hospitalized twice for lengthy periods of times, yet none of the doctors has ever been willing to ask me how I perceived his behavior.

We are currently separated as his most recent incident escalated into a situation where he became violent (although he still maintains he remembers nothing of the violence or threats) and could easily have killed someone. There were numerous witnesses to his bizarre behavior that day, yet he maintains it never happened, that he was the victim.

My question: I am afraid to allow him to return to the home under any circumstances, despite his crying and begging, his promises to seek treatment and change. Yes, he is seeking treatment, but only because I had him forcibly removed from the home and ordered into the hospital by the court. It has now been seven weeks, and it appears to me that his condition is worse than ever. He can’t carry on a coherent conversation, although he is a highly educated man; he sends e-mail that makes no sense, full of misspellings and incomplete thoughts. He “stalks” me telephonically, calling repeatedly despite my insistence that he not call more than once a day, in the evening. He claims that his medications are supposed to “kick-in” after 8 weeks and that then I can “trust” him again.

I don’t know if I love this man; I don’t know if I’ve ever even known who he is, separate from the BPD. He has never been “normal,” although he is extremely attractive and can be very charming and persuasive when he wants. He has been unimaginably verbally abusive to my daughter and I, both. At the moment, my daughter is seen as EVIL (his description, in several letters to me) and I am a goddess, doing what was necessary to preserve our home and marriage.

If he is not being treated for the BPD, if he continues on his present course of medications, how will I know if it is safe to let him return? His is not a mild case; he is totally dysfunctional. While I would not want to throw away a marriage if there is a chance to salvage it, a chance for both of us to have meaningful and rewarding lives, I will not under any circumstances allow a return to what has been happening here. His doctors won’t discuss his case with me, as I said. He presents very well as a victim, particularly to women doctors who apparently have difficulty hearing what he isn’t saying, seeing past the tears and the obvious emotional turmoil. At one point about 10 years ago a tentative diagnosis of BPD was made and a suggestion of treatment in a hospital on the east coast was rejected by my husband and his other doctors. He wants to come home to recover; I have to refuse unless there is some assurance of proper treatment and eventual recovery. What can I do and what should I look for?

A. I treat many people in similar situations, and I am continually reminded of just how much suffering there is in this world. Much of it seems so unnecessary.

You bring up many important issues. First you are not “a co-dependent personality.” There is no such thing. You have self-esteem problems, thought patterns, and behavior patterns that have destroyed much of your life. No matter what happens to your husband, your life will continue to be miserable as long as you live in a manner that ALWAYS leads to misery. Your daughter’s road will be a very difficult one as well, and her best hope is for you to become a happy, successful, peaceful person. There is a consistent fact of life, your adolescent and adult children will only listen to you about life if you’ve got the kind of life they want. Do as I say not as I do won’t ever cut it.

Can you be happy, loving, peaceful and successful? Yes, it’s not only possible, but it’s mostly in your hands. The past only establishes habits and automatic thinking patterns, it has nothing to do with the future.

First you need to find out if any biologically treatable disorders are present in you. Many people with disorders such as the BPD associate with “worse” borderlines so they don’t feel the need to improve themselves, whether that fits you or not I don’t know, but it is common. Get the medical treatment you need, and make sure your doctors and therapists explain the diagnoses and treatments so you know what’s going on. It is your life. The Internet and many books are available for information.

Next is acquiring better information. Most people like you assume you know what to do, and keep trying ineffective plans over and over again. Good psychotherapy can be enormously useful in this regard, particularly if you are determined to succeed and are looking for someone to assist you in your goals, not to be a paid friend.

The next step is reading. I often tell my patients, “when all else fails, read the directions!” I would recommend the following books to you immediately: “Your Erroneous Zones” by Wayne Dyer, “Looking Out for Number One” by Robert Ringer, “How to Win Friends and Influence People” by Dale Carnegie, “Embraced By the Light” by Betty Eadie and “Are You the One for Me?” by Barbara DeAngelis. Most problems have to do with perspective and understanding, not what is actually happening. Everything you do that hurts you hurts you, everything you do that helps you helps you.

You need to retrain your thinking as well. I would strongly recommend you immediately purchase Zig Ziglar’s tape series “How to Stay Motivated.” You need to listen over, and over, and over, and over again. Stop watching the news and listening to painful music, and start listening and learning about how to have the life you want. The 18 tapes cost around $225. Many people consider that to be too expensive, yet waste more than that on alcohol, cigarettes, soft drinks instead of water, etc. A visit to a marriage counselor, or a few visits with an attorney over a DUI or drug arrest for a child or you makes you realize that $225 would have been a great investment. There is no law preventing you from working part time for a few weekends (convenience stores are a good source of income) in order to pay for them. The telephone number is 1-800-527-0306. Tina Downey has been helping my patients. I have absolutely no financial incentive or relationship with Mr. Ziglar or his tapes.

Regarding your husband:

There is no such thing as a “breakdown.” A “bad childhood” is a partial explanation for what happens to us, but it’s only the past. A “bad adulthood” is not necessary. Many enormously successful and important people have had a “bad childhood.” He clearly has multiple neurological problems, that don’t appear to be adequately treated medically – particularly if you review the literature on the BPD. Xanax is sometimes necessary, particularly for panic, but has been shown to make borderlines lose behavior control more often. I did a small study comparing Prozac with Zoloft, and Prozac was clearly and dramatically better. Depakote in particular is excellent for bipolar disorder, but isn’t as effective as Tegretol for the BPD and behavioral seizures (which could cause the memory loss).

Certain behaviors are totally unacceptable: violence, stalking, being nice “when he wants.” Why not all the time? Isn’t that the kind of relationship you want? Those books will help. There are two things necessary for a great relationship, and you can have one: 1) you have to be the kind of person the kind of person you want wants, and 2) you have to know what you want. How can you hit a target if you have no idea what the target is and no idea how to reach the target?

You are having trouble looking out for your own best interests, although you are starting to change this. You wrote “I don’t know if I love this man,” “he is totally dysfunctional,” “he has never been normal,” “he has been unimaginably verbally abuse to my daughter.” You also wrote “while I would not want to throw away a marriage if there is a chance to salvage it, a chance for both of us to have meaningful and rewarding lives, I will not under any circumstances allow a return to what has been happening here.”

The BPD wasn’t effectively diagnosed or treated until a few years ago. Borderlines can have very happy and successful lives, but I’ve never seen anyone reach that point who wasn’t totally committed to happiness and success, read the books, and was well treated medically – and enthusiastically took the medication – grateful for the opportunity to have a great life instead of resentful that medication was necessary. Without question the borderlines who listen to Ziglar the most did the best.

Your last question was “What can I do and what should I look for?” – the last paragraph answered that question. He has to be totally committed to doing the same things I recommended to you. When you do all these things together with commitment and love, you have an excellent chance.

The opposite of co-dependency is self-responsibility. No one has the power to make you feel bad but you. Happiness is a choice, and a happy, successful life is a series of choices, perspectives, and knowledge. Many people like you have trouble acting out of your own best interests, and this recommendation usually clarifies things: “what advice would you give your daughter if she was in this situation?” I wish you well and I hope I was of some help.

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Borderline Personality Disorder Dysphoria and Treatment

Q. How do I tell when what I am going through is Dysphoria?

I have emotional storms that are extremely painful, and seem to be a combinations of depression, some anger, fear and despair, all at once, along with racing thoughts I can’t follow; I just feel like being alive is a mistake when I get like that. My suicidal ideation is worse then. I also feel a lot of stress, I feel like something inside of me is about to snap… Is this *anything* like Dysphoria? Or is this just “feeling bad”?

These “episodes” vary in strength and quality, the emotion that dominate can change. There are times when I go into states that are more slow, depressive but not exactly. It’s like things slow down inside me; it takes me longer to respond to what happens around me, I feel a little disconnected from the rest of the world (just a little). this feeling is like floating around in a bubble, seeing everything but through a thin layer. And if someone insists on talking to me and I have to be responsive, I kind of “snap out of it” and after about a minute, it can go away… I didn’t notice how much my behavior/perception were affected by some of these episodes until one day, when I was taking the subway to somewhere while feeling disconnected (after a bad therapy session), someone tried to explain to me how to use the turnstile — I guess I looked a little disoriented and like I didn’t know what to do, because I was doing everything slower, and thinking about what to do next took more time… and this is just one kind of “episode.”

While there are those times when I slow down, other times I get incredibly tense. I remember having “attacks” of terrible distress when I was going through depression a few years ago, and they were so unbearable that they drove me to self-mutilate to get rid of the pain. They were different from the feeling of depression. The ones I have now are not as bad; so I am not sure if this is even Dysphoria. I often don’t even know what causes me to feel this way. It’s like a build-up of despair that just erupts all of the sudden; other times, it happens because I feel rejected, self-loathing, hated or guilty. Is this treatable?

One thing I should probably mention is that, unlike most BPDs, although I grew up in a very problematic family, I did not have a traumatic childhood and I was not abused.

I guess the disconnecting thing is when my feelings reach a state of overload. Another reaction I get when it’s too much is feeling nothing — being numb, functioning well but being “dead” inside. I must admit that there are times when I find it useful and count on it when I have to go through something painful; I don’t know how to “turn it on”, but somehow it happens. Sometimes the numbness turns into euphoria. I am completely confused about this.

Sometimes I take mild sedatives when I can’t stand the tension, but they rarely do anything. I just lay in a dark room or stare at the wall. Sometimes these feelings–esp. the stress– are triggered by things like someone saying they’ll come over and being late; not being able to get someone on the phone; expecting something that I know should happen — even if nothing goes wrong, the expectation alone makes me go crazy. I try to remind myself of the reality, that I am not being rejected, but it does not help at all. Once my mind starts this kind of a cycle it’s like it doesn’t know how to stop.

I’m in therapy, and it’s helped me control my anger and violent outbursts (for which I will feel guilty for the rest of my life, as I should), but we have not found a solution for this emotional vulnerability yet. Other than the “episodes” I was talking about, I generally suffer from tension (to the degree that I get extremely annoyed by sounds; I go ballistic when a neighbor plays his radio a little too loud, or the TV in the other room is on, while other people in the house get angry for a minute, then shrug it off), and, on the other hand, a complete lack of energy, concentration and interest in anything.

A. I’ve never seen a better description of dysphoria, dissociation, psychosis or the urge for self-mutilation.

These are all a form of seizures.

Dysphoria is anxiety, rage, depression and despair – and it gets progressively worse and worse. The pain from it is unbearable.

The reason you do the self-mutilation (painful stimuli) is that for whatever reason the dysphoria stops.

All these things are neurological and can be controlled by the right sequence and combination of medications. I usually start Prozac at 20mg daily and 1 week later tegretol mid day. In cases like yours the dysphoria resolves in 3-4 hours. Your meds then need to be adjusted and then you have to move on to a happy and successful life.

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Borderline Personality Disorder: How Can BPD be a Brain Injury When Many BPDs Have a History of Abuse?


Q. I think it is fairly well defined that my spouse is BPD, or at least she has “text-book” profile according to all my research, admittedly on the layman level. In any case, I just read on this site the discussion about renaming BPD to something else based partly on what seemed to me a complete physical or biological explanation for the actions/reactions of “borderlines”. I may have misunderstood the point here, but if this is the thrust of the idea, then how does the “chemical imbalance” view square with the other criteria I have read: childhood abuse (physical, sexual, neglect, etc.), adolescent failures, early and failed marriage, now into near-failed second marriage, etc.? Not that I am asking for an either/or answer here, and certainly I am not pleased with the BPD label.

A. The name of the diagnosis is a horrible label. The BPD seems to be where psychological trauma and physical trauma cause the same processes in the brain. It appears to be from brain injury. It’s not a “chemical imbalance” – it’s a brain injury that fortunately can now be treated with non addicting medications.

The majority of the symptoms are from brain malfunction and the person’s adaptation to those malfunctions. The medical symptoms are moodiness, chronic anger, emptiness, boredom, dysphoria (anxiety, rage, depression, despair), dissociation, and feeling like a “cornered animal.” The ability to handle stress is also markedly reduced. Stressors trigger a worsening of the above symptoms.

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Borderline Personality Disorder, PTSD & Bi-polar Disorder

Q. I have been diagnosed differently many times. The 2 major ones have always been BPD and PTSD. I have recently moved to another state and started therapy again. Now I am diagnosed with BPD and Bi-Polar disorder. I asked about if I still had PTSD and I was told that PTSD only lasts 6 months, if the symptoms continue after that it is no longer PTSD but Bi-Polar psychosis. Do you feel this is true?

A. No. Virtually everything I’ve read and seen shows the PTSD doesn’t go away, but can wax and wane. It can become dramatically less with medication and counseling, particularly cognitive retraining.

Q. My old therapist who I had for 5 yrs. does not agree. My background is childhood physical, sexual and emotional abuse. I was also adopted at the age of 5 months.

A. Very high likelihood of the BPD, but obviously I cannot make that diagnosis. The key feature separating the impulsivity and self-destructiveness of the BPD vs bipolar is that bipolars start to feel good, then great, then invincible – participating in their self-destructive activities because they believe nothing bad can happen to them (or an equivalent idea). Borderlines participate in self-destructive behaviors because they feel terrible and the self destructive behaviors relieve the pain.

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Borderline Personality Disorder: Sexual Abuse & Biological Basis

Q. I’ve enjoyed browsing the informative, caring web site you’ve produced, as well as Dr. Heller’s contributions.

I am a woman diagnosed with BPD a couple years ago, in my early 30s. I’m in therapy and started meds (Serzone) several months ago (no help yet). I have self-injured since I was a teenager, am eating-disordered, and now have some problems with alcohol abuse. I am “obsessed” with finding out why I am like this. Because I can think about past incidents now with little to no emotion, I have a hard time figuring out if an incident was significant enough or not (such as mother telling me she hated me, wished I was dead, etc.) to have had some impact on my development.

How can you gauge this? There are some hints of early childhood sexual abuse, but I have no memories of anything. Because I can’t find a cause, I blame myself for being like this. I’d also like to know if there are any guidelines for what constitutes sexual abuse of teenagers (such as strangers exposing themselves and masturbating in front of you, or being touched inappropriately while asleep). What sort of impact might that have on a teenage girl already suffering from depression and anger? I have a really hard time believing your biological theory and think that I must be to blame. Thanks for your help.

A. When I read your letter my thought was “where do I begin.”

First and foremost, the child is never, ever to blame for sexual abuse. Even if a child acts sexually inappropriately he/she needs to be punished and taught to stop doing that. The adult is always wrong to respond with sexual behaviors.

All the examples you described are horrible sexual abuses and absolutely inappropriate. The inappropriate behaviors and particularly the lack of concern for how you were doing would of course make a depressed and angry child worse.

Your likelihood of having the BPD seems very, very high. Medication could have a huge initial effect for you, although you will almost certainly need multiple medications.

Regarding your difficulty believing the biological basis of the BPD and other problems, I’m saddened for you that you are also burdened by believing things that aren’t true. If you believed you were a giraffe that doesn’t mean you are a giraffe. I highly encourage you to check out the facts. Your hatred towards yourself and others is blinding you to what life can bring to you.

Just remember, it never was your fault. Perpetrators of sexual abuse commonly blame the child or try to convince the child that she/he is bad. Unfortunately it sounds like you believed those perpetrators.

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Borderline Personality Disorder: Woman with BPD, PTSD, & Seizures Experiences Reaction to Prozac

Q. You recommend Prozac plus Tegretol as the best treatment for borderline personality disorder.

I have been diagnosed with BPD, PTSD/dissociation and recurrent depression. I also have difficult-to-control seizures, caused by a childhood head injury.

I am currently taking Tegretol, Neurontin and Sabril, all prescribed for my epilepsy.

Several months ago, I was prescribed Prozac. I had an *extremely* bad reaction to this – a severe mixed state with psychosis (the first psychotic episode of my life).

Other antidepressants (including Aropax/Paxil) have triggered hypomania in me.

Given that I’m already on Tegretol, and can’t tolerate Prozac (and other antidepressants)– what would you recommend?

I strongly object to the “borderline” label, and don’t meet the full DSM-IV criteria for the disorder– but I certainly relate to your description of “chronic dysphoria”.

A. Interesting questions. I also don’t like the “borderline label.” If you chronically experience moodiness, chronic anger, emptiness, and boredom even doing things you enjoy the BPD diagnoses seems more likely. I’m obviously not your physician, and your physicians have had their hands full with your neurological problems.

Take a good look at the criteria for the Generalized Anxiety Disorder, particularly the “cognitive component” – SSRI’s often trigger worsening anxiety until the GAD is pretreated.

Secondly, it sounds like you are getting bipolar episodes (there’s actually a bipolar diagnosis for those who only get it when taking medication). There are some options. Depakote (valproic acid) is another seizure medication that works as well as lithium for the bipolar disorder.

A patient like you sometimes requires pretreatment with medications to prevent consequences. I am not your physician, and I do not know the details.

If I had a patient like you in my office, I would carefully explain what was wrong, explain the risks, and then if and only if the patient wants to try a different plan I would probably recommend that the following things be done: 1) check all the diagnoses – psychiatric and medical – and make a plan of treatment, 2) add depakote, 3) make certain all the epilepsy drugs that require blood monitoring are being monitored and in the upper half of normal, 4) add a good antipsychotic medication such as Risperdal or Zyprexa to prevent psychosis, and then 5) starting with an extremely low dose gradually begin Prozac. This approach will likely have lots of side effects – particularly grogginess, but after the depression and dysphoria were gone for a few months, the medications could slowly be reduced and some stopped.

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